Interaction of metals, menopause and COVID-19: A review of the literature Original paper

What was reviewed?

This review article comprehensively examines the interplay between metal exposures, menopause, and COVID-19. The authors synthesize current evidence on how environmental and dietary exposure to metals, including heavy metals such as arsenic, cadmium, mercury, and lead, influences the onset and course of menopause and, in turn, how these factors may impact susceptibility to and outcomes from COVID-19. The review highlights the hormonal, metabolic, and immunological changes during menopause and how these are modulated by metal exposures, with a particular focus on trace minerals’ role in immune competence and the severity of SARS-CoV-2 infection.

Who was reviewed?

The review synthesizes data from epidemiological studies, clinical research, and mechanistic investigations involving women at various menopausal stages across diverse populations exposed to environmental metals. While some cited studies focus on the general female population, others investigate specific cohorts such as women in polluted regions, those with occupational metal exposure, or patients with COVID-19. Both human and relevant animal studies are included to elucidate pathogenic mechanisms, and supporting data from male and pediatric populations are referenced for context.

Most important findings

The review identifies several key microbiome-relevant associations and signatures. High blood levels of heavy metals, including arsenic, cadmium, lead, and mercury, are linked to disruptions in endocrine function, earlier or altered onset of menopause, and increased risk of age-related diseases such as osteoporosis and cardiovascular disease. For instance, arsenic exposure is associated with an earlier menopause, while cadmium can mimic estrogenic effects but also disrupt ovarian function and the timing of menopause. In postmenopausal women, mobilization of bone lead increases blood lead levels, potentially exacerbating toxic effects. Metal exposures are further implicated in modulating the immune response to SARS-CoV-2, with higher levels of toxic metals correlating with impaired respiratory function and more severe COVID-19 outcomes. Conversely, deficiencies in essential trace elements are associated with increased COVID-19 severity and poorer recovery. The review notes potential benefits of supplementation with zinc, magnesium, and selenium, especially in postmenopausal women, to support both immune function and mitigate the toxic effects of heavy metals.

Key implications

For clinicians, these findings underscore the importance of monitoring metal exposures and trace element status in menopausal and postmenopausal women, particularly in the context of the ongoing COVID-19 pandemic. Screening for and addressing deficiencies in zinc, selenium, and magnesium may be warranted to reduce vulnerability to severe COVID-19 and counteract the deleterious effects of heavy metals. The review also suggests that environmental and occupational history should be part of menopausal risk assessment, and that hormone replacement therapy may have added benefits in supporting immune resilience during viral infections. The need for further research into the interaction between environmental pollutants, metal metabolism, menopausal transition, and the gut microbiome is highlighted, especially for the development of personalized interventions and microbiome-informed risk stratification.